title: Factors influencing referral of patients with voice disorders from primary care to otolaryngology.
abstract: OBJECTIVE
  To evaluate the frequency, timing, and factors that influence referral of patients with laryngeal/voice disorders to otolaryngology following initial evaluation by a primary care physician (PCP).
  
  
  METHODS
  Retrospective analysis of a large, national administrative US claims database.
  
  
  METHODS
  Patients with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by a PCP as an outpatient (with or without otolaryngology involvement), and continuously enrolled for 12 months were included. Patient age, gender, geographic region, last PCP laryngeal diagnosis, comorbid conditions, time from first PCP visit to first otolaryngology visit, number of PCP outpatient visits, and number of PCP laryngeal diagnoses were collected. Cox and generalized linear regressions were performed.
  
  
  RESULTS
  A total of 149,653 unique patients saw a PCP as an outpatient for a laryngeal/voice disorder, with 136,152 (90.9%) only seeing a PCP, 6,013 (4.0%) referred by a PCP to an otolaryngologist, and 3,820 (2.6%) self-referred to an otolaryngologist. Acute laryngitis had a lower hazard ratio (HR) for otolaryngology referral than chronic laryngitis, nonspecific dysphonia, and laryngeal cancer. Having multiple comorbid conditions was associated with a greater HR for otolaryngology referral than having no comorbidities. Patient age, gender, and geographic region also affected otolaryngology referral. The time to otolaryngology evaluation ranged from <1 month to >3 months. PCP-referred patients had less time to the otolaryngology evaluation than self-referred patients.
  
  
  CONCLUSIONS
  Multiple factors affected otolaryngology referral for patients with laryngeal/voice disorders. Further education of PCPs regarding appropriate otolaryngology referral for laryngeal/voice disorders is needed.
authors.affiliation: Duke Voice Care Center, Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
authors.forename: Seth M
authors.initials: SM
authors.lastname: Cohen
authors.forename: Jaewhan
authors.initials: J
authors.lastname: Kim
authors.forename: Nelson
authors.initials: N
authors.lastname: Roy
authors.forename: Mark
authors.initials: M
authors.lastname: Courey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014832:Voice Disorders / Q000175:diagnosis / Q000628:therapy; D055815:Young Adult
keywords: Laryngeal disorders; dysphonia; referral; voice; voice disorders